Reflections of a Dietetic Intern Through the Inaugural WVU ISPP Class

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While being in my Institutional Food Service, Production, and Management rotation this summer, a common concern from management has come to my attention. And this concern would be… Food Allergies!

A food allergy is the body’s immune system reaction to certain foods. Symptoms of an allergic reaction include itching or swelling in or around the mouth, face, and scalp; tightening in the throat; wheezing or shortness of breath; hives; abdominal cramps, vomiting, diarrhea; loss of consciousness; and even death.

Food allergies are a growing public health concern. As many as 15 million people in the U.S. have food allergies. An estimated 9 million, or 4%, of adults have food allergies. Nearly 6 million, or 8%, of children have food allergies with young children affected the most. Although children allergies to milk, egg, wheat, and soy generally resolve in childhood, they appear to be resolving more slowly than in previous decades, with many children still allergic beyond age 5 years. Allergies to peanuts, tree nuts, fish, or shellfish are generally lifelong allergies.

The top food allergens are categorized into eight food groups. These eight food groups account for 90% of all food-allergic reactions. They include: milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat. The estimated prevalence among the American population is:

–Milk and eggs: based on data within and obtained outside the United States, this rate is likely to be 1-2% for young children and 0.2-0.4% in the general population.

The Centers for Disease Control and Prevention reported that food allergies result in more than 300,000 ambulatory-care visits a year among children under the age of 18 years. From 2004 to 2006, there were approximately 9,500 hospital discharges per year with a diagnosis related to food allergy among children under age 18 years. Even small amounts of a food allergen can cause a reaction. Most allergic reactions to foods occurred to foods that were thought to be safe. Allergic reactions can be attributed to a form of mislabeling or cross-contact during food preparation. Food allergy is the leading cause of anaphylaxis outside the hospital setting. Every 3 minutes a food allergy reaction sends someone to the emergency department. This is approximately 200,000 emergency department visits per year, and every 6 minutes the reaction is one of anaphylaxis. Teenagers and young adults with food allergies are at the highest risk of fatal food-induced anaphylaxis. Symptoms of anaphylaxis may recur after initially subsisting and experts recommend an observation period of about 4 hours to monitor that the reaction has been resolved. Individuals with food allergies who also have asthma may be at an increased risk for severe or fatal food allergic reactions. Children with food allergy are 3-4 times more likely to have other related conditions such as asthma and other allergies, compared without food allergies. It is possible to have anaphylaxis without any skin symptoms (no rash or hives). Failure to promptly (i.e., within minutes) treat food anaphylaxis with epinephrine is a risk factor for fatalities.

Chemical contamination can occur when high-acid foods are prepared or stored in metal-lined containers. Poisoning may result if brass or copper, galvanized, or gray enamelware containers are used. Fruit juices should never be stored in gray enamelware with lead glaze or tin milk cans. Cases of poisoning have been recorded that have been attributed to use of improper metal utensils. Sauerkraut, tomatoes, fruit gelatins, lemonade, and fruit punches have been implicated in metal poisonings.

Toxin metals also have been implicated in food poisoning cases. Copper may become poisonous when it is in prolonged contact with acid foods or carbonated beverages. The vending industry voluntarily discontinued all point-of-sale carbonation systems that do not completely guard against the possibility of backflow into copper water lines. Also, food such as meat placed directly on cadmium-plated refrigerator shelves may be rendered poisonous.

With the beginning of summer, many people think they can just keep their picnic food safe from bacteria by storing it in the refrigerator. But, there is one bacteria- that is exempt from that rule…

Unlike most food bacteria, Listeria can grow in cool temperatures. Refrigerating food already contaminated with these bacteria could allow the germs to multiply and spread, according to the USDA.

The bacteria can cause serious illness known as listeriosis, which is especially dangerous for children, older people, pregnant women, and those with compromised immune systems. Foods in which Listeria has been found include deli meats, hot dogs, smoked seafood and store-prepared salads. The FDA advises those at greater risk for developing listeriosis to reheat these ready-to-eat foods until they are steaming hot. They should also avoid unpasteurized milk and soft cheeses.

Listeriosis has also been linked to contaminated cantaloupes. The FDA recommended washing all fruits and vegetables under running water immediately before eating, cutting or cooking them. Firm produce, in particular, should be scrubbed with a produce brush. Examples like this, is specifically important in the summer when fruits are in season.

Other ways to prevent Listeria infection include:

–Set your refrigerator temperature to 40 degrees F or lower to slow the growth of Listeria. Use a refrigerator and freezer thermometer to make sure temperatures are appropriately cold.

–Wrap or cover food before placing it in the refrigerator. Be sure no containers or covers are leaking juices on other foods.

–Do not allow cooked or ready-to-eat (RTE) foods to sit in the refrigerator. Eat these foods right away so Listeria doesn’t have the opportunity to grow. If you have leftovers in your refrigerator, it’s best to throw them out after 3 days, just to be sure. Because remember, it’s always better to be safe than sorry!

–Clean up refrigerator spills immediately. The FDA notes leaks or spills from hot dog packages, raw meat or poultry are mostly of concern. The agency advised cleaning these spills with paper towels to avoid spreading germs to a cloth towel.

–Routinely disinfect the refrigerator. Cleaning the inside walls and shelves of the refrigerator with warm water and soap. Surface cleaners can also be used monthly.

–Sanitize kitchen surfaces where food is prepared with soap and water and surface cleaner.

–Wash cutting boards after every use. Nonporous acrylic, plastic, or glass boards can be sanitized in the dishwasher.

–Wash dish cloths, towels and cloth grocery bags in the hot cycle of the washing machine.

–Before and after handling food, wash your hands with warm water and soap for at least 20 seconds! And if you can’t remember how long- just sing the “Happy Birthday” song. This is a trick we educate children on for food safety and hand washing!

According to the Center of Disease Control and Prevention (CDC), over 70 people in America have become sick because of a salmonella outbreak connected to imported Mexican cucumbers. The CDC reported that 14 people have been hospitalized and are trying to identify other people who could have been infected.

The source of the outbreak is thought to be Mexican supplier Daniel Cardenas Izabal and Miracle Greenhouse of Culiacan, Mexico. The cucumbers were distributed by Tricar Sales Inc. of Rio Rico, Ariz., the CDC said.

The Food and Drug Administration (FDA) has stopped the imports by Cardenas Izabal and Miracle Greenhouse unless they can prove that their cucumbers are not contaminated with salmonella. As of this point, California has reported the highest number of people who have fallen sick- 28. Among these people, the majority of them became sick between January 12th and April 6th. The outbreak reportedly reached its peak in early March but, the contaminated cucumbers have been pulled from shelves and are no longer on the market. But, the number of ill-stricken people could still rise. Due to the time it takes between when a person becomes ill and when the illness is reported, more sick people could come forward.

Most persons infected with Salmonella bacteria develop diarrhea, fever, and abdominal cramps 12 to 72 hours after infection. For example, the illness usually lasts 4 to 7 days, and most people recover without treatment. In some cases, the diarrhea may be so severe that the patient needs to be hospitalized-due to dehydration. Salmonella infection may spread from the intestines to the bloodstream and then to other body sites and can cause death unless the person is treated promptly with antibiotics. Children younger than 5 years, older adults, and persons with compromised immune systems are more likely than others to develop severe illnesses Salmonella.

Due to the recent government sequester that went into effect on March 1st, 2013, the Food and Drug Administration (FDA) will administer fewer number of food safety inspections throughout the country. While American consumers may not feel the impact immediately, the loss of $209 million from its budget will force the FDA to conduct about 2,100 less inspections. This reduction in food inspections account for an 18% decline compared to last year. The funding loss will also delay the agency’s implementation of the 2011 Food Safety Modernization Act.

Not only are food-borne illnesses (FBI) of concern but, the approval of new drugs are as well. All of the programs within the FDA are at risk for being compromised because of the huge cuts that are taking place. The Sequester is becoming a really big hit and I think that more and more people will start to experience that, and in turn realize its significance. The FDA does plan to prioritize programs that have the greatest effect on the public’s health, including disease outbreaks.

These next statistics are so ridiculous to me…. According to the Center for Disease Control and Prevention (CDC), 1 in 6 Americans, which equals 48 million people, develop a FBI each year. Out of these people, 3,000 people die and 128,000 are hospitalized. The FDA is already facing serious criticism, not to mention legal actions, for being slow to implement the food safety law. This law is geared towards refocusing the FDA’s efforts on prevention, instead of responding to crises. Since the law was signed into effect in 2011, it sat for 2 years with the White House Office of Management and Budget where it was rewritten in ways that weakened FDA’s oversight. The FDA claims that they’re frustrated with this situation, as is the rest of the country. The more time that goes by without this law going into effect, the more people that are at-risk of getting seriously sick.

But, I don’t believe that the FDA is as innocent as they might be leading on. Even before the Sequester, the FDA was able to inspect less than 2% of all food imports.

Children deficient in vitamin D at age one are more likely to have food allergies, but only if their parents are born in Australia. This is based on researcher’s findings in Melbourne, Australia.

In a study of 5000 children, researchers from the Murdoch Children’s Research Institute found that one-year-olds with vitamin D deficiency were 3 times more likely to have a food allergy than those whose levels were adequate.

Children with two or more allergies were 10 times more likely to have vitamin D deficiency, according to the study, published in the Journal of Allergy and Clinical Immunology.

The lead researcher said there was some evidence that vitamin D could play an important role in regulating a child’s immune system in the first year of life. It was likely that reduced diversity of bacteria in the gut due to increased hygiene explained the current food allergy epidemic, with vitamin D and an infant’s diet also plays a crucial factor.

Vitamin D deficiency was linked to food allergies only in children of Australian-born parents, which could be because they may have more diverse gut microbes.

”I personally think the hygiene hypothesis is very critical but in that context I think there’s a second factor, which is vitamin D and what we eat in first year of life.”

”It’s probably the two coming together at a critical moment in history which has driven this quite bizarre situation in the past 20 years where food allergies are on the rise.”

Australia has one of the highest rates of food allergy in the world, affecting more than 10% of infants.

Australia also had one of the highest rates of vitamin D deficiency, and was one of the few countries that did not fortify foods with vitamin D or provide supplements to infants.

”This study provides the first direct evidence vitamin D sufficiency may be an important protective factor for food allergy in the first year of life. We’re excited by these results, because what this suggests is there may be a modifiable factor that we can actually change and do something about to turn back the tide in the food allergy epidemic.”

Food allergies are obviously a concern to new parents and their young children. Children with food allergies are two to four times more likely to have other related conditions such as asthma and other allergies, compared with children without food allergies.

From 2004 to 2006, there were approximately 9,500 hospital discharges per year with a diagnosis related to food allergy among children under age 18 years, in the U.S. From 1997 to 2007, the prevalence of reported food allergy increased 18% among children under age 18 years.

These numbers alone, represent the alarming epidemic of food allergies that are affecting people of every age and on every continent of the world. Not only are children in danger of potential allergic reactions but, parents are the responsible parties that have to take precautions and manage their child’s everyday diet.

Well, ladies and gentlemen, the world has now seen it all! Edible advertising has entered the already corrupt world of beverage marketing. The Coca-Cola soda brand, Fanta, has recently released a new print advertisement tactic geared towards your taste buds, literally. The soda company has launched, what it claims to be as the first edible print advertisement. The advertisement begins its print with whimsical fonts spelling out alluring and persuading phrases. Then the advertisement invites consumers to physically tear out the page and EAT it. Yes, I said EAT THE PAGE. They do this is consumers can “taste” the flavors for themselves. This type of advertising is really taking amplified reality to a whole different level.

I personally, cannot believe that I have lived to see the day that this is actually happening. I mean, it’s bad enough that there is an epidemic of childhood obesity. So, as a multimillion dollar soda company, I see that Coca-Cola/Fanta is really taking the initiative at combating this problem… By creating an even more open avenue for children at becoming exposed to increased sugar sweetened beverages. Yes why of course- that WOULD make sense (insert sarcasm here).

“Consuming added sugars has been tied to an increased risk for heart disease among adolescents and cholesterol problems”, according to the CDC. More than one-third of American children and adolescents are currently obese. And these numbers are directly related to the over consumption of sugary beverages… like soda! So, instead of creating more avenues of sugar sweetened beverage exposure, especially to child populations, big beverage companies like these should be advocating the opposite. I’ll admit, the marketing tool, itself, is a good idea. But NOT when there are national government agencies attempting to tackle a problem like this. It’s like a slap in the face to America and its youth’s future.